A novel screening strategy for clinically significant prostate cancer in elderly men over 75 years of age

A standard modality for prostate cancer detection in men 75 years and older has not been established. A simple screening method for elderly patients is needed to avoid unnecessary biopsies and to effectively diagnose prostate cancer. A retrospective study was conducted on elderly patients who had prostate biopsy at Kanazawa University Hospital (Kanazawa, Japan) between 2000 and 2017. Of the 2251 patients who underwent prostate biopsy, 254 had clinically significant prostate cancer (CSPC) with a Gleason score (GS) of >= 7 and 273 had a GS of <7 or no malignancy. In this study, patients aged 75 years or older were classified as elderly patients. GS >= 7 was characterized by a prostate-specific antigen (PSA) of the maximum area under the curve of 12 ng ml-1 with a sensitivity of 76.2% and a specificity of 73.2%. For PSA levels between 4 ng ml-1 and 12 ng ml-1, based on the maximum area under the curve, patients with three or four of the following factors may present a GS of >= 7: percent free PSA >24, PSA density >= 0.24 ng ml-2, positive findings on digital rectal examination, and transrectal with 90.0% sensitivity and 67.4% specificity. In this study, we found that raising the PSA cutoff to 12 ng ml-1 for CSPC in elderly individuals can significantly reduce unnecessary prostate biopsies. Furthermore, CSPC could be efficiently discovered by combining the four supplementary markers in patients with a PSA level of 4-12 ng ml-1. By performing this screening for elderly men over 75 years of age, unnecessary biopsies may be reduced and CSPC may be detected efficiently.